Payment Reform

Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicare Advantage, and State Medicaid ProgramsExternal Link

Publication June 9, 2017
Health Care Payment Learning and Action Network
This report provides results of a study – the largest and most comprehensive of its kind – measuring use of Alternative Payment Methodologies (APMs) among public and private health plans that agreed to participate in the study. Conducted from May 19, 2016 to July 13, 2016, the findings capture actual health care spending from 2015 and provide an estimate of spending as of January 2016 across commercial, Medicare Advantage, and Medicaid market segments.

Filed In:

  • Payment Reform

Data Sharing Requirements Initiative: Collaborative Approaches to Advance Data SharingExternal Link

Publication June 9, 2017
Health Care Payment Learning and Action Network
The report is designed to help leaders - including providers, payers, and employers - who are working, or wish to work, in alternative payment models (APMs) to understand what information they will need from outside their organization and the processes involved in obtaining that information. It is also an aid for third party entities, including vendors, policymakers and others that provide access to the data sources and data sharing processes that support APM efforts.

Filed In:

  • Measurement and Reporting
  • Payment Reform

Accelerating the Implementation of Value-based Care and Payment: Recommendations from the 2016 National Payment Reform SummitExternal Link

Publication June 9, 2017
Network for Regional Healthcare Improvement
Stakeholders who are developing Alternative Payment Models (APMs) face a number of challenges, and those implementing or receiving care supported by APMs have concerns about APM design and potential negative consequences poorly-constructed APMs may have on patients, providers, payers and communities. Recommendations for addressing eight of these challenges were developed by the the 80 national health care leaders who participated in the 2016 National Payment Reform Summit.

Filed In:

  • Community Convenings
  • Payment Reform

Payment Reform Series No. 3 - The Building Blocks of Successful Payment Reform: Designing Payment Systems that Support Higher–Value Health CareExternal Link

Publication June 9, 2017
Network for Regional Healthcare Improvement
Many physicians, hospitals, and other providers across the country find that the current fee–for–service payment system creates barriers to implementing or sustaining better approaches to health care delivery. Consequently, payment reforms must be an integral part of any strategy to create a higher–value health care system. This white paper describes the building blocks for successful payment reform and how communities might approach these building blocks to meet their unique circumstances.

Filed In:

  • Payment Reform

Payment Reform Series No. 2- Advancing Transparency to Reform Payment: The Top Dos and Don’ts from Regional Multi-Stakeholder CollaborativesExternal Link

Publication June 9, 2017
Network for Regional Healthcare Improvement
This document features advice from leading Regional Health Improvement Collaboratives (RHICs), including ones in California, Ohio, Colorado, Maine, Minnesota, Oregon, and Missouri,that have been advancing their communities toward greater transparency of cost and quality information for years and overcoming barriers of all kinds.

Filed In:

  • Community Convenings
  • Payment Reform

Payment Reform Series No.1 - Moving From Quality to Value: Measuring and Controlling the Cost of Health CareExternal Link

Publication June 9, 2017
Network for Regional Healthcare Improvement
This issue brief describes why the industry must move beyond common but insufficient methods of measuring cost of care, and toward total cost of care, and what types of entities are well-positioned to lead this work. It presents five core components of measuring, analyzing, and reporting total cost, and presents the challenges associated with this task.

Filed In:

  • Measurement and Reporting
  • Payment Reform

From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims DataExternal Link

Resource November 1, 2016
Network for Regional Healthcare Improvement
Over three years, Regional Health Improvement Collaboratives, working collectively through the Network for Regional Healthcare Improvement, have demonstrated the ability to assess, refine and standardize raw regional healthcare cost data and use it to establish meaningful, local practice level reports and comparisons within and between healthcare markets. This work advances healthcare cost transparency, a necessity for solving the healthcare cost crisis. This report summarizes key findings.

Filed In:

  • Measurement and Reporting
  • Payment Reform

NRHI’s Getting to Affordability Learning Module Series External Link

Resource November 1, 2016
The Network for Regional Healthcare Improvement
NRHI has launched its Learning Module series, aimed at enabling participants to learn first-hand from the HealthDoers in the field. Join the Getting to Affordability social learning community at this link to access the eight modules that provide training on technical and stakeholder engagement aspects of measuring and reporting Total Cost of Care (TCoC) locally and regionally. In the community you can also access resources, and talk with the TCoC project team and other community members.

Filed In:

  • Payment Reform

Accelerating and Aligning Population-Based Payment Models: Data SharingExternal Link

Publication August 24, 2016
Health Care Payment Learning and Action Network (LAN)
This white paper offers guiding principles and recommendations that should be considered in data sharing arrangements in Population-Based Payment models. The paper outlines a series of “use cases” for data sharing that describe particular types of data sharing arrangements, in both their current and aspirational states. The goal is to create an environment where data follows the patient and is available to all stakeholders (patients, providers, purchasers, and payers) in a timely manner.

Filed In:

  • Payment Reform

Comprehensive Primary Care (CPC+) Practice Application Info Session

Webinar August 11, 2016
Q Corp

Oregon has been selected as one of fourteen regions to take part in the CPC+ initiative that will start on January 1, 2017. Practice applications for CPC+ are now open on the online portal through September 15, 2016. The CMS website has practice application questions, along with additional important information for practices and vendors regarding Health IT requirements (Appendix B and C from the original RFA).

Filed In:

  • Payment Reform

Data Sharing: Accelerating and Aligning Population-Based Payment ModelsExternal Link

Presentation May 24, 2016
Health Care Payment Learning and Action Network (LAN)
This slide deck from the Health Care Payment Learning and Action Network presentation on April 26, 2016 is helpful in understanding an overview of the Population-Based Payment Work Group’s preliminary recommendations related to sharing data within a population-based payment model, and share stakeholders' perspectives for implementation of draft recommendations.

Filed In:

  • Payment Reform

Alternative Payment Model White PaperExternal Link

Publication January 12, 2016
Health Care Payment Learning and Action Network
The National Health Care Payment Learning and Action Network Alternative Payment Models Framework and Progress Tracking Work Group was charged with creating an Alternative Payment Model (APM) Framework that could be used to track progress towards payment reform. Composed of diverse health care stakeholders, the Work Group deliberated and reached consensus on many critical issues related to the classification of APMs, resulting in a rationale and a pathway for payment reform.

Filed In:

  • Payment Reform